Health professionals from north-western Syria learn how to prevent cholera and handle an outbreak. During a simulation exercise, they practise setting up and operating a cholera treatment centre. The WHO field office in Gaziantep, Turkey, organized the training.

From its field office in Gaziantep, Turkey, close to the border with Syria, WHO conducted a training to prepare more than 30 Syrian doctors for preventing and responding to a potential cholera outbreak.

Years of conflict have damaged water and sanitation systems in Syria, and violence has forced thousands of people to flee their homes. So far, there have been outbreaks of diarrhoeal disease but no cases of cholera. However, if cholera cases were to occur, the combination of damaged sewage systems and population movement could trigger an outbreak. Displaced people in Syria’s camps are particularly at risk as contact with sewage is likely.

The training, held in October 2017, aimed to ensure that staff on the ground in Syria are prepared to prevent the spread of cholera and treat patients in the event of a cholera outbreak. Training is particularly important in Syria as many doctors and health workers have left the country, and the few who remain often lack qualifications.

Participants learned about cholera prevention, diagnosis and treatment, and practised setting up a cholera treatment centre in a simulation exercise using an empty warehouse. They will in turn train their colleagues when they go back to Syria.

Experts from WHO and the Centers for Disease Control and Prevention (CDC) of the United States of America guided the classroom sessions and practical training.

Knowing the appropriate treatment can save lives

Cholera, a diarrhoeal disease that spreads through contaminated water and food, “is easily treatable,” says Dr Kathryn Alberti. Dr Alberti is from the cholera team at WHO headquarters and was a trainer in Gaziantep. “But when it’s severe, patients can die of dehydration.”

Most patients have mild diarrhoea that can be treated with oral rehydration, but severely dehydrated patients need intravenous (IV) rehydration and antibiotics. “It’s quite shocking how quickly people get dehydrated,” explains Dr Alberti, who led WHO’s response to cholera outbreaks in Haiti and Nigeria, “and shocking to see the state they arrive in.”

“You always plan for the worst-case scenario,” instructed Dr Colleen Hardy, Field Epidemiologist with the CDC, during the training. “Think of things like road traffic – will it block patients from getting to the centre quickly? Put the response centre near where the sick people are.”

During the simulation, Syrian staff worked from diagrams to set up beds, buckets and handwashing stations. They discussed infection prevention and how to manage patient flow to minimize the spread of the disease.

Preventing cholera in conflict-torn Syria

WHO has long been working with Syrian health staff to prevent cholera. “We have a meeting every month to make sure we are prepared,” says WHO Public Health Officer Dr Tasnim Atatrah, who serves in the field office in Gaziantep. “We collaborate with health-care facilities and local communities to support them.”

In Gaziantep, WHO pre-positions cholera kits that include oral rehydration salts, IV solutions, zinc and other supplies, storing them in north-western Syria in case of an outbreak. WHO also strengthens the ability of laboratories in Syria to test samples for cholera.

The cholera training, storage of cholera kits and capacity-building for laboratories are part of the wider activities of WHO’s Gaziantep field office to provide health services to northern Syria. These include vaccination campaigns, training for health-care workers in northern Syria, delivery of medicines and other supplies, preparation for outbreaks, treatment of injuries and noncommunicable diseases, provision of primary health care to more than a million people, and mental health support.

“There hasn’t been a cholera outbreak in Syria for years,” says Dr Atatrah, “and we want to keep it that way.”